Preparedness for mass casualties and major accidents

Most calls involve one patient and your task is to give the best treatment you can to that one person. In a mass casualty incident — a major accident or event with many injured at once — the logic reverses: the task becomes distributing a limited amount of resources so the most people survive rather than using all capacity on the first patient you meet.

§Regional health emergency plans

All regions and municipalities must, according to the National Board of Health's framework, develop health emergency plans that are revised at least every four years. The plans describe how the health service – including the pre-hospital response – should be able to scale up and handle incidents that exceed daily, normal capacity, ranging from train accidents and explosions to major traffic accidents involving many people.

§Triage: sorting by urgency

When many are injured at once, you can't examine and treat everyone thoroughly from the start. So triage is used—a quick sort where each patient gets a priority based on how urgent their treatment need is. A widespread method internationally is START (Simple Triage And Rapid Treatment), which in under a minute per patient assesses breathing, circulation, and consciousness level and based on that assigns a color code.

§Cooperation across authorities

A mass incident typically involves multiple agencies at once: police rescue services and health services. Normally an incident commander is appointed for each agency on site including a health incident commander who has overall responsibility for organizing the health professional effort distributing patients among responding units and coordinating which hospitals can receive how many patients. As an ambulance worker you take part in that structure and follow the incident commander's instructions instead of acting alone based on what you encounter first.

§Mentally prepare for the unusual

Mass casualties are rare but precisely because of that practice and knowledge of principles are crucial — it is not something you can improvise through the first time it happens for real. Knowing the framework for triage and organisation in advance means you can find your place in the response more quickly when chaos at first can feel overwhelming.

§After the effort — evaluation and learning

When a mass casualty event is over, the job is not quite finished. Most emergency services systematically evaluate the response afterward: Did triage work as expected? Was communication between units clear enough? Was there enough material and personnel in the right places? This kind of evaluation helps improve both plans and training for next time, and as a paramedic, your experience from the scene is an important part of the foundation the evaluation is based on.

For you as an ambulance handler mass casualties are therefore one of the areas where preparation matters most. Know the plans practise triage regularly and be aware that your role in the first minutes — overview notification and quick sorting — can become just as important for the total number of lives saved as the clinical treatment you later give the individual patient.